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iPQ <br /> .IBC S N APTL> *i JCE <br /> Intake &Approval Sheet R PERMIT STAFF ONLY) •RMIT# ? 0, —ate6- <br /> Mir <br /> BUILDING PLANNING <br /> Intake OK by: Date: Intake OK by: Assign To: Date: <br /> Intake Comments: Intake Comments: <br /> Zone (--1 2 <br /> ❑Make this a"W"Permit 0 SRC Required(Pre-lnsp) Overlay/Agreement <br /> Bldg/TI/AddnlRem Size / '4 Nonresidential Use W hoc 114 ,k. <br /> Garage/Accessory Struct.Size Residential Use <br /> Number of Stories I Proposed No.of Dwelling Units: <br /> Basement 1No DYes, Fin/Unfin Total No.of Dwelling Units: <br /> Type of Construction Planning/Landscape Inspection Required before Final? DYes ❑No <br /> Occupancy Group £(LC, "In Lieu"Fee:Type: Amount$ <br /> Occupancy Load '�L School Impact Fee: Total $ .-- <br /> Cert.of Occpuancy Required? lictNo DYes ❑Shell Only Calculated: Credit: <br /> Code Year 02021 02018 ❑2015 DEverett School Dist ❑Mukilteo School Dist <br /> Fire Sprinklers: ❑Update Existing ONew System Not Req'd Park Impact Fees for permits applied for after 11112022: <br /> Reason Sprinklers Required: Park Impact Fee Total$ ' (net due after credit for existing uses) <br /> Fire Alarm: DUpdate Existing❑New System Not Req'd Fee Schedule Used For Calculation(Year): <br /> Reason Fire Alarm Required: <br /> RCW 64.55 MF worksheet req`d for permit? DYes to No <br /> Add'I RCW.64.55 does required prior to final? Oyes No Additional�Al Notes:l 1A/ Ir7 ) G <br /> VALUATION CALCULATION: Total$ I k 1 rs 3 to �. 1 U!v ' IQ a �/I/ _l <br /> Approved By: Date: <br /> PUBLIC WORKS • . <br /> Intake OK by: Date: <br /> Intake Comments: PW Review&Worksheet Needed if: <br /> 'DSys Dev Eval: <br /> Additional Notes: I ['Water ❑Sewer ❑Storm <br /> II:Traffic Mitigation Eval <br /> Approved By: CA (t,c.„„,o,, Date: G -115 VI;,,a,( IDSite Work/Drainage(shown/triggered) <br /> IDAddress Letter <br /> FIRE DEPARTMENT _ jDBackflow Prevention for high hazard: <br /> Separate/Deferred Submittals Required: !hospii(dentatal, <br /> supportivemupot animals,mortuary, <br /> p q hospital, housing) <br /> ❑Fire Sprinklers ❑Fire Alarm ❑Other: 1 <br /> Additional Notes: 0 This Permit is Approved by Public Works <br /> ❑See PW Review Worksheet and associated attached items <br /> Fire Dept.Fees: ❑A Separate PW Permit is Required(Permit#:PW ) <br /> ❑Review of As-Built Plans-NO FIRE FEE AND 0 Is fully digital <br /> ❑ Minimal or No Fire Scope-NO FIRE FEE 0 Is located in this folder <br /> Review/Inspection Scope-ADD FIRE FEE ❑ Is in a Separate Green Folder(loin with this folderfor permit issuance) <br /> Approved By: ,,,t)- ca(,my\ Date: / "3e 2G/ ❑Will be issued separately(Separate Green Folder,PW issued ahead of Bldg) <br /> Public Works has no scope on this permit---PW Not Required <br /> • ELECTRICAL/PLUMBING dditional Notes: <br /> Additional Notes: ` <br /> Approved By: Date: Completed By: Date: C fijt.1' <br /> t 14 z( <br />